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We read with great interest the study by Huo et al, which provides a valuable contribution by characterising the long-term prognosis of metabolic dysfunction-associated steatotic liver disease (MASLD) among lean individuals.1 Aligned with previous studies,2–4 the authors reported that lean patients with MASLD demonstrated a higher risk for the development of liver-related events and all-cause mortality but a lower risk for cardiovascular disease than their non-lean counterparts. Their analyses on diverse adverse outcomes with long follow-up durations are a major strength. Comprehensive sensitivity and subgroup analyses with thorough covariate adjustment confirm the robustness of conclusions.